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Nath R, Rathi V, Ish P. Tuberculosis notification in India-current trends and the road ahead. Indian J Tuberc 2024; 71:114-116. [PMID: 38589113 DOI: 10.1016/j.ijtb.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Ravindra Nath
- Department of Community Medicine, VMMC and & Safdarjung Hospital, New Delhi, 110029, India
| | - Vidushi Rathi
- Department of Pulmonary Medicine, VMMC & Safdarjung Hospital, New Delhi, 110029, India
| | - Pranav Ish
- Department of Pulmonary Medicine, VMMC & Safdarjung Hospital, New Delhi, 110029, India.
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Ricks S, Singh A, Sodhi R, Pal A, Arinaminpathy N. Operational priorities for engaging with India's private healthcare sector for the control of tuberculosis: a modelling study. BMJ Open 2024; 14:e069304. [PMID: 38508628 PMCID: PMC10952976 DOI: 10.1136/bmjopen-2022-069304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (JEET), the largest private sector engagement initiative for tuberculosis (TB) in India. DESIGN We developed a mathematical model of TB transmission dynamics, coupled with a cost model. SETTING Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage. PARTICIPANTS Estimated patients with TB in Ahmedabad and New Delhi. INTERVENTIONS We investigated the epidemiological impact of expanding three different public-private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services. RESULTS Our results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000-US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000-US$29 000). CONCLUSION Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.
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Affiliation(s)
- Saskia Ricks
- Imperial College London School of Public Health, London, UK
| | - Ananya Singh
- Clinton Health Access Initiative, New Delhi, India
| | | | - Arnab Pal
- Clinton Health Access Initiative, New Delhi, India
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Shah HD, Yasobant S, Patel J, Bhavsar P, Saha S, Sinha AK, Saxena D, Patel Y, Nimavat PD, Bhavesh M. Deaths among tuberculosis patients of the western state of India: A secondary record based analytical study on its determinants. Indian J Tuberc 2023; 70:390-397. [PMID: 37968043 DOI: 10.1016/j.ijtb.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/11/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION India has a significant TB burden, and ongoing attempts are being made to eradicate the disease. Globally, the number of TB deaths is declining, but not quickly enough to meet the End TB Goals. The National Strategic Plan (NSP) 2017-2025 in India set in motion an ambitious effort to expand the scope and efficacy of the National Tuberculosis Elimination Program (NTEP). METHODS A descriptive retrospective study based on secondary data was conducted on information obtained from the electronic TB notification register for 2019, abstracted from Ni-kshay. Further, descriptive analysis was undertaken to identify the factors associated with deaths and successful treatment outcomes. The binomial logistic regression model estimates the crude relative risk and a 95% confidence interval to describe the association between predictor variables and TB treatment outcomes. RESULTS After applying the eligibility criteria for the study population, a total of 1,44,643 (88%) TB patients were included in the study. 1,35,934 (94%) TB patients had completed the treatment and survived, while 8709 (6%) TB patients died. A significant association of treatment outcomes was observed in age, gender, key population, site of diseases, type of case, type of health facilities, HIV and Diabetes. When a logistic regression was applied, the model showed the association of the independent variables with the risk of death in TB patients. CONCLUSION The epidemiological factors associated with treatment outcomes among TB patients should be audited systematically. A structure of TB death surveillance and response system should be established with a mortality audit, including a community-based death review (CBDR) and a facility-based medical audit (FBMA) in case the patient is hospitalized or discharged from a hospital.
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Affiliation(s)
- Harsh D Shah
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India.
| | - Sandul Yasobant
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Jay Patel
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Priya Bhavsar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Somen Saha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Anish K Sinha
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Deepak Saxena
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India; School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Yogesh Patel
- CGC Division, Country Office, World Health Partners, New Delhi, India
| | - Pankaj D Nimavat
- State TB Office and State Training and Demonstration Center, Department of Health and Family Welfare, Government of Gujarat, India
| | - Modi Bhavesh
- Community Medicine, AIIMS, Rajkot, Gujarat, India
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Sinha R, Rana RK, Kujur A, Jahnavi G, Kumar M, Venugopal V, Priya N, Kujur M, Jha RR, Barnwal R, Nishant N, Murmu N, Pathak R, T A, Prasad R, Dayal R, Modi B, Purty AJ, Bn S, Nair D, Kumar D. Trends of Private Drugs' Sales and Costs Incurred by Patients on Anti-tuberculosis Drugs in Selected Districts of Jharkhand (2022): Results From Sub-national TB-Free Certification. Cureus 2023; 15:e47296. [PMID: 38021489 PMCID: PMC10656432 DOI: 10.7759/cureus.47296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The government of India is committed to eliminating tuberculosis (TB) by 2025 under the National Tuberculosis Elimination Programme which provides free investigations and treatment as well as incentives for nutritional support during their treatment course. Many TB patients prefer to seek treatment from the private sector which sometimes leads to financial constraints for the patients. Our study aims to find the burden of TB patients in the private sector and the expenses borne by them for their treatment. METHODOLOGY Sales data of rifampicin-containing formulation drug consumption in the private sector of six districts of Jharkhand was collected from Clearing and Forwarding agencies. Based on the drug sales data, the total incurring costs of the drugs, total number of patients, and cost per patient seeking treatment from the private sector were calculated for the year 2015-2021. ANOVA and the post hoc test (Tukey honestly significant difference (HSD)) were applied for analysis. RESULTS There was a marked difference amongst all the districts in relation to all the variables namely total costs, cost per patient, and total private patients seeking treatment from the private sector which was statistically significant (p < 0.001). East Singhbhum had the highest out-of-pocket expense and private patients as compared to all six districts. Lohardaga showed the sharpest decline in total private patients from 2015 to 2021. The average cost borne by private patients in 2015 was INR 1821 (95% CI 1086 - 2556) which decreased to INR 1033 (95% CI 507 - 1559) in 2021. CONCLUSION From the study, it was concluded that the purchase of medicines for TB treatment from the private sector is one of the essential elements in out-of-pocket expenditure (OOPE) borne by TB patients. Hence, newer initiatives should be explored to foresee the future OOPE borne by the patients and decrease OOPE-induced poverty.
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Affiliation(s)
- Ratnesh Sinha
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, IND
| | - Rishabh K Rana
- Department of Preventive and Social Medicine/Community Medicine, Shaheed Nirmal Mahto Medical College and Hospital (Erstwhile Patliputra Medical College), Dhanbad, IND
| | - Anit Kujur
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - G Jahnavi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Mithilesh Kumar
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vinayagamoorthy Venugopal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Neha Priya
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Manisha Kujur
- Department of Preventive Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ravi Ranjan Jha
- Department of Community Medicine, Shaheed Nirmal Mahto Medical College and Hospital (Erstwhile Patliputra Medical College), Dhanbad, IND
| | - Rajan Barnwal
- Department of Community Medicine, Mahatma Gandhi Memorial Medical College and Hospital, Jamshedpur, IND
| | - Nikhil Nishant
- Department of Community Medicine, Medinirai Medical College, Palamu, IND
| | - Nisha Murmu
- Department of Preventive Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Rajeev Pathak
- NTEP Technical Support Network, World Health Organization, Ranchi, IND
| | - Anupama T
- NTEP Technical Support Network, World Health Organization, Ranchi, IND
| | - Ranjit Prasad
- State TB Cell, Health Services, Government of Jharkhand, Ranchi, IND
| | - Rakesh Dayal
- State TB Cell, Health Services, Government of Jharkhand, Ranchi, IND
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Sharath Bn
- Department of Community Medicine, Employees' State Insurance Corporation (ESIC) Medical College and Post Graduate Institute of Medical Science & Research (PGIMSR), Bengaluru, IND
| | - Dina Nair
- Department of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, IND
| | - Dewesh Kumar
- Department of Community Medicine/Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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Sahasrabudhe T, Barthwal M, Sawant T, Ambike S, Jagtap J, Hande S, Atre S. Tuberculosis notification: An inquiry among private practitioners in Pimpri-Chinchwad municipal corporation area of Maharashtra, India. Indian J Tuberc 2022; 69:73-78. [PMID: 35074154 DOI: 10.1016/j.ijtb.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Government of India implemented mandatory TB notification policy since 2012. After that India's TB notifications from the private sector steadily increased; however, less is known about private practitioners' (PP's) experiences with TB notification. The present study aims to fulfil this gap. METHODS We conducted a cross-sectional study during November 2019 to March 2020 in Pimpri-Chinchwad Municipal Corporation (PCMC) area of Maharashtra State. We used a mixed methods approach which involved a survey of 200 PPs and in-depth interviews (IDIs) with 7 PPs and 8 National TB Elimination Program (NTEP) staff. The data were presented in the form of frequencies and percentages and thematic analysis was performed on the qualitative data. RESULTS The study revealed that most PPs (194 of 200; 97%) were aware of TB notification and 75% reported that they notify TB cases to the NTEP. Of those who notify, majority (129 of 145; 89%) reported that they use paper-based notification being the convenient method due to in-person visit and help by the NTEP staff. Only a third of PPs were aware of electronic notification methods. The main reasons behind low utilization of web based and mobile application were unfamiliarity and technical issues such as poor network connectivity. A third of PPs were aware about monetary incentives for notification and only 17% reported actual receipt of incentive at some point. CONCLUSIONS Our study identifies several areas where the NTEP can undertake interventions to strengthen the implementation of mandatory TB notification policy. Low awareness about electronic notification methods and preference for paper-based notification in this Study area suggest that more efforts are necessary for successful transitioning from paper-based to electronic notification system.
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Affiliation(s)
- Tushar Sahasrabudhe
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Madhusudan Barthwal
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Trupti Sawant
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Sunil Ambike
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Jayshri Jagtap
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Shashank Hande
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Sachin Atre
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India.
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Sridhar S, Balachandran K, Nazirudeen R, Natarajan V, Sangumani J. Clinical Profile of Addison's Disease in a Tertiary Care Institute, Southern India - The Changing Landscape. Indian J Endocrinol Metab 2022; 26:50-54. [PMID: 35662761 PMCID: PMC9162256 DOI: 10.4103/ijem.ijem_164_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/26/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Aims and Objectives Clinical, biochemical, and radiological profiles of Addison's disease and to assess the various etiological spectrum of primary adrenal insufficiency (PAI) in adults. Materials and Methods A retrospective cohort study was carried out in the Department of Endocrinology, Madurai Medical College, Madurai between January 2014 and January 2021 over a 7-year period. Inclusion Criteria All the patients with clinical symptoms and or signs of suspected PAI, such as hyperpigmentation, weight loss, persistent nausea or vomiting, fatigue, and hypotension, were recruited. All suspected cases underwent measurement of 8-AM plasma ACTH and cortisol levels. In possible cases and equivocal cortisol levels, patients underwent Co-syntropin/ACTH stimulation test. To know the underlying etiology of PAI, 21-hydroxylase autoantibodies (21OHAb), thyroid function test, Anti TPO, calcium, parathyroid hormone (PTH), LH and FSH, CT of chest and abdomen, and sputum AFB based on the clinical pattern of involvement were performed. Exclusion Criteria Patients with onset of PAI at infancy and childhood, secondary adrenal insufficiency or exogenous Cushing's syndrome, and central hypocortisolism, including Sheehan's syndrome, were excluded. Results Thirty-six patients were diagnosed with PAI in this study; 19 (53%) were females and 17 were males (47%). The median age of diagnosis was 35 years. Patients were divided into acute presentation and subacute presentation. Twenty-six patients presented with acute presentation and ten were presented with progressive evolved symptoms. Non-tuberculous etiology was the predominant finding noted in our cohort study (87%, 31 out of 36 patients). The other causes of Addison disease included isolated auto-immune PAI, polyglandular autoimmune syndrome type 1 and II, APLA Syndrome, and adrenal metastasis. Conclusion Non-tuberculous causes of PAI are the leading etiology in our retrospective study. Autoimmune PAI and Polyglandular autoimmune syndromes are increasingly being recognized as the cause of Addison's disease. PAI individuals require lifelong surveillance for possible development of coexisting autoimmune syndromes and need for glucocorticoid/mineralocorticoid therapy.
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Affiliation(s)
- Subbiah Sridhar
- Department of Endocrinology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Karthik Balachandran
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Roshan Nazirudeen
- Department of Endocrinology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Vasanthiy Natarajan
- Department of Endocrinology, Madurai Medical College and Govt. Rajaji Hospital, Madurai, Tamil Nadu, India
| | - Jayaraman Sangumani
- Department of Endocrinology, Madurai Medical College, Madurai, Tamil Nadu, India
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How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study. BMC Public Health 2021; 21:71. [PMID: 33413206 PMCID: PMC7791821 DOI: 10.1186/s12889-020-10053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April–June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB. Results Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG (Bacillus Calmette–Guérin) scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP). Conclusion This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.
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Kunwar R, Srivastava VK. Operational Research in Health-care Settings. Indian J Community Med 2019; 44:295-298. [PMID: 31802787 PMCID: PMC6881894 DOI: 10.4103/ijcm.ijcm_4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rajesh Kunwar
- Department of Community Medicine, TS Misra Medical College, Department of Community Medicine, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V K Srivastava
- Department of Community Medicine, TS Misra Medical College, Department of Community Medicine, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kumar D, Bhardwaj AK. Feasibility of a mobile based Continuing Medical Education (CME) program for recent updates in the medical colleges of Himachal Pradesh, India. Indian J Tuberc 2019; 66:58-63. [PMID: 30797284 DOI: 10.1016/j.ijtb.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 02/09/2018] [Accepted: 04/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mobile based messaging system provides a platform to communicate to health care professionals of medical colleges for an updated knowledge in Revised National Tuberculosis Control Program (RNTCP) in the state of Himachal Pradesh. MATERIAL AND METHODS Pragmatic trial under routine programmatic conditions was planned in which an automated messaging system was developed along with development of message banks tailored for medical faculty (total 335) with respect to their discipline. RESULTS Message banks were developed by the research team by referencing the relevant training modules and guidelines under RNTCP. Two message banks consisted of relevant message lines were developed; one was for case notification, revised presumptive definition, and revised diagnostic methods and general information and another one was for INDEX-TB guidelines. Different combinations -input system - of message lines were decided and designed for both message banks. Input system was kept for one-month cycle with delivery of messages on fixed day and at fixed time (usually at 19:00h on a selected day) to ensure sustained interest and effective reading time for messages. CONCLUSION Mobile based medical education program to the medical faculties proved to be feasible and useful to keep them updated about recent changes in the RNTCP.
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Affiliation(s)
- Dinesh Kumar
- Associate Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
| | - Ashok Kumar Bhardwaj
- Professor, Department of Community Medicine, Dr. RadhaKrishnan Government Medical College, Hamirpur, Himachal Pradesh, India
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Dias HMY, Pai M, Raviglione MC. Ending tuberculosis in India: A political challenge & an opportunity. Indian J Med Res 2018; 147:217-220. [PMID: 29923507 PMCID: PMC6022383 DOI: 10.4103/ijmr.ijmr_660_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Madhukar Pai
- McGill Global Health Programs; Department of Epidemiology & Biostatistics, McGill International TB Centre, McGill University, Montreal, Canada
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TB Notification from Private Health Sector in Delhi, India: Challenges Encountered by Programme Personnel and Private Health Care Providers. Tuberc Res Treat 2017; 2017:6346892. [PMID: 28845306 PMCID: PMC5563408 DOI: 10.1155/2017/6346892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 04/26/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To identify the challenges encountered by private health care providers (PHCP) to notify tuberculosis cases through a programme developed web-based portal mechanism called “NIKSHAY.” Study Design. It is a descriptive qualitative study conducted at two revised national tuberculosis control programme (RNTCP) districts of New Delhi. The study included in-depth interviews of PHCP registered with “NIKSHAY” and RNTCP programme personnel. Grounded theory was used to conceptualise the latent social patterns in implementation of tuberculosis case notification process and promptly identifying their challenges. Results The analysis resulted in identification of three broad themes: (a) system implementation by RNTCP: it emphasizes the TB notification process by the RNTCP programme personnel; (b) challenges faced by PHCP for TB notification with five different subthemes; and (c) perceived gaps and suggestions: to improvise the TB notification process for the private health sector. The challenges encountered by PHCP were mainly related to unsystematic planning and suboptimal implementation by programme personnel at the state and district level. The PHCP lacked clarity on the need for TB notification. Conclusion Implementation of TB notification among private health care providers requires systematic planning by the programme personnel. The process should be user-friendly with additional benefits to the patients.
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Mishra GP, Mulani J. Patients with tuberculosis in the private sector: counting the uncounted. THE LANCET. INFECTIOUS DISEASES 2017; 17:134-135. [PMID: 28134104 DOI: 10.1016/s1473-3099(17)30013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/04/2016] [Accepted: 12/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Gyanshankar P Mishra
- Department of Respiratory Medicine, Government Medical College, Nagpur, Maharashtra, India.
| | - Jasmin Mulani
- Regional Mental Hospital, Nagpur, Maharashtra, India
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Law S, Piatek AS, Vincent C, Oxlade O, Menzies D. Emergence of drug resistance in patients with tuberculosis cared for by the Indian health-care system: a dynamic modelling study. LANCET PUBLIC HEALTH 2017; 2:e47-e55. [DOI: 10.1016/s2468-2667(16)30035-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 12/01/2022]
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The Tuberculosis Cascade of Care in India's Public Sector: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002149. [PMID: 27780217 PMCID: PMC5079571 DOI: 10.1371/journal.pmed.1002149] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/09/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world's "missing" patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The "cascade of care" is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions. METHODS AND FINDINGS The care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India's TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014-2015), one WHO dataset (2015), and three RNTCP reports (2014-2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000-2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB-including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB. The WHO estimated that there were 2,700,000 (95%CI: 1,800,000-3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775-1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival. The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India. CONCLUSIONS Increasing case detection is critical to improving outcomes in India's TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.
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Arinaminpathy N, Batra D, Khaparde S, Vualnam T, Maheshwari N, Sharma L, Nair SA, Dewan P. The number of privately treated tuberculosis cases in India: an estimation from drug sales data. THE LANCET. INFECTIOUS DISEASES 2016; 16:1255-1260. [PMID: 27568356 PMCID: PMC5067370 DOI: 10.1016/s1473-3099(16)30259-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/22/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022]
Abstract
Background Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation. Methods We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013–14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis. Findings There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2–6 months, this implies that 1·19–5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed. Interpretation India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nimalan Arinaminpathy
- MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, London, UK.
| | | | - Sunil Khaparde
- Central TB Division, Government of India, New Delhi, India
| | | | | | | | - Sreenivas A Nair
- World Health Organization, India Country Office, New Delhi, India
| | - Puneet Dewan
- Bill & Melinda Gates Foundation, New Delhi, India
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